tbuckley/cabot-search huggingface dataset:
Abstract 13632: The Optimization of Mechanical Circulatory Support Device Combination Considering Ventricular Load in Biventricular Failure Condition: A Simulation Study
Authors: Hiroki Matsushita, Takuya Nishikawa, Shohei Yokota, Midori Kakuuchi, Aimi Yokoi, Akitsugu Nishiura, Kazunori Uemura, Toru Kawada, Meihua Li, Keita Saku
Journal: Circulation (2022)

Backgrounds: Recently, the combination of Impella, a percutaneous transvalvular left ventricular assist device, and veno-arterial extracorporeal membrane oxygenation (ECMO) have improved the survival rate of cardiogenic shock by its powerful hemodynamic support effect. Meanwhile, the optimal flow control of those devices remains unclear, especially in biventricular failure (BVF). In this study, we established the mathmatical cardiovasular simulation model, and evaluated how the combination therapy impacts both right (RV) and left (LV) ventricular loading. Methods: We used SimulinkⓇ (Mathworks, Inc.) for the simulation. Both the systemic and pulmonary circulation were modeled by using 5-element resistance-capacitance net-work. Four cardiac chambers were represented by time-varying elastance with unidirectional valves (Fig. 1). In LV dysfunction (LV end-systolic elastace was set at low level: 0.4 mmHg/ml), we compared the changes of right (RAP) and left (LAP) atrial pressure, as the marker of ventricular loading, under various RV function and Impella and ECMO flows. Results: Impella slightly increased RAP and reduced LAP regardless of RV systolic function (Fig. 2). In high pulmonary vascular resistance (PVR), the increase of Impella flow augumented RAP, while Impella could not be up-titrated more than 2.8 L/min due to LV suction (Fig. 3). In BVF with high PVR, ECMO decreased RAP and increased LAP in each Impella flow (Fig. 4). Higher ECMO and Impella flows rendered LV extremely small, induced suction, and increased RV preload and RAP. Conclusion: PVR is the major determinant of stable Impella support without inducing RV loading and LV suction. In BVF with high PVR, ECMO reduced RV loading, while decreased LV filling and induced LV suction by Impella. The preemptive simulation study for an individual patient may help the optimal use of mechanical circulatory support device to maximize RV and LV unloading with improving hemodynamics.
Abstract 13142: Development of a 30-Day Health Status Prediction Model for High-Risk Transfemoral Carotid Artery Stenting Using a Simple Machine Learning Algorithm
Authors: Kristie M Harris, Gaelle Romain, Jacob Cleman, Carlos Mena-Hurtado, Kim G Smolderen
Journal: Circulation (2022)

Introduction: Individualized prediction models for transfemoral carotid artery stenting (TF-CAS) health status outcomes have not been developed. We applied a machine learning algorithm to identify the most robust pre-procedural predictors of 30-day TF-CAS health status, and validated models across different health status measures to maximize generalizability. Methods: The 390-center SAPPHIRE registry enrolled high-risk patients undergoing TF-CAS from 2006-2014, containing two cohorts with pre-procedural and 30-day health status assessments: Cohort 1 (n=4,667) had EQ-5D-3L (Index and Visual Analog Scale [VAS]); Cohort 2 (n=3,594) had SF-36 (Mental [MCS] and Physical [PCS] Component Summary scores). A random forest algorithm ranked the importance of 50 pre-procedural variables (pre-procedural health status, modified Rankin and NIH stroke scores, demographics, comorbidities, and disease characteristics) for 30-day health status in each cohort. Selection thresholds were based on visual inspection of the importance plots to evaluate the information gain value of each variable considered. Overlapping variables across health status measures were retained to develop a multivariable linear regression model to predict 30-day health status in each cohort. Results: Importance plot ( Figure ) inspection yielded 23 variables, each of which had importance values &gt;15% for ≥2 of the 4 health status measures. From these, 7 overlapping variables were ultimately retained in the linear regression analyses that predicted ~40% of the variance (R 2 =.39-.45) for 30-day TF-CAS health status, including pre-procedural health status, age, heart failure, history of stroke, Rankin stroke score, renal disease, and pulmonary disease. Conclusions: Seven easily assessed pre-procedural variables robustly predicted TF-CAS health status. This model can inform the risk-benefit analysis underlying the TF-CAS medical decision-making process for patients and clinicians.
Abstract 133: Association Between Bystander Physical Limitations And Delays In Chest Compression During T-CPR
Authors: Amanda L Missel, Christopher Drucker, Kosuke Kume, Jenny Shin, Robert W Neumar, Peter J Kudenchuk, Thomas Rea
Journal: Circulation (2022)

Background: Promptly initiated bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA). Many OHCA patients require repositioning (e.g., moved to hard surface) to improve chest compression (CC) quality, which can delay CC. We examined the association between repositioning, CC delay, and patient outcomes. Methods: We used quality improvement data from review of 911 dispatch audio recordings of OHCA in adults eligible for telephone CPR (T-CPR) in King County, WA between 2013 and 2021. OHCA was categorized into 3 groups: CC not delayed, CC delayed due to bystander-reported physical limitations to reposition the patient, or CC delayed for other reasons. The primary outcome was delay in CC defined as the interval between start of T-CPR instructions and CC onset. We performed Kruskal-Wallis and Chi Square tests to evaluate global differences and post-hoc analyses with Bonferroni correction for pairwise differences. Results: Of the 3,483 OHCA patients eligible for T-CPR, median age was 64, 35% were women, 45% were witnessed, 23% had an initial shockable rhythm, and 15% survived to discharge. T-CPR was not delayed between instructions and compressions in 1,618 patients (46%), was delayed due to bystander physical limitations in repositioning the patient in 1,218 (35%), and was delayed for other reasons in 647 (19%). The interval from T-CPR instruction to CC onset was longest for the physical limitations delay group (121 secs, IQR: 69) compared to the other delay group (88 secs, IQR: 65) and the no delay group (54 secs, IQR: 36) (all comparisons p&lt;.05). Bystander CPR was less frequent in the physical limitations delay group (74%) versus no delay (100%) or the other delays group (81%, all comparisons p&lt;.05). In the physical limitation delays group, 154 (13%) of patients ultimately received bystander CPR on a soft surface (e.g., bed). This group also had the lowest hospital discharge survival (11%, p&lt;.05) versus the no delays (17%) and other delays group (17%). Conclusion: Bystander physical limitations are a common barrier to repositioning patients to begin CPR. Repositioning delays were associated with lower likelihood of receiving CPR, longer times to begin CC, and lower survival rates.
Abstract 138: Epinephrine Before Defibrillation In Adults With Shockable Rhythm Out-of-hospital Cardiac Arrest
Authors: Shengyuan Luo, Liwen Gu, Wanwan Zhang, Yongshu Zhang, Wankun Li, Feipeng Qiu, Yan Xiong, Ahamed H Idris
Journal: Circulation (2022)

Introduction: Guidelines recommend epinephrine treatment after the first defibrillation in the resuscitation of patients with shockable rhythm cardiac arrest. Degrees to which routine practice adheres to clinical guidelines can be variable. Hypothesis: Epinephrine was administered prior to defibrillation in a non-trivial proportion of patients with shockable rhythm out-of-hospital cardiac arrest (OHCA). Such practice is associated with worse outcomes. Methods: We conducted a retrospective study in a North American OHCA epidemiologic registry between 2011 and 2015. We assessed the proportion of participants with shockable rhythm OHCA who received pre-defibrillation epinephrine and described their characteristics. In a propensity-matched cohort, we used logistic regression to evaluate associations between pre-defibrillation epinephrine and outcomes, i.e., pre-hospital return of spontaneous circulation (ROSC), survival to hospital discharge, and favorable neurological outcome (modified Rankin Scale score ≤3) at discharge. Results: Of 6938 individuals with shockable rhythm OHCA, 522 (7.5%) received epinephrine before defibrillation. Comparing these patients to those who did not receive pre-defibrillation epinephrine, mean time from emergency medical services activation to first defibrillation was longer (17.5 vs 10.5 min) and a greater proportion received epinephrine intra-osseously (24 vs 20%). In total, 392 (75%) and 5119 (80%) gained prehospital ROSC, 78 (15%) and 1237 (19%) survived to hospital discharge, and 48 (9%) and 996 (16%) had favorable functional outcome at discharge respectively. In propensity-matched analysis, epinephrine use prior to defibrillation was associated with statistically insignificant increases in odds of prehospital ROSC (OR=1.20, 95%CI 0.89-1.61; p=0.23), survival (OR=1.46, 95%CI 0.98-2.17; p=0.06), and favorable neurological outcome at hospital discharge (OR=1.21, 95%CI 0.76-1.93; p=0.43). Conclusions: Data from a North American OHCA registry found that epinephrine can be administered prior to defibrillation in up to 7.5% of patients with shockable rhythm cardiac arrest. Such approach was not associated with worse outcomes in propensity-matched analysis.
Abstract 13279: Effects of SBT-255 on Myocardial Infarct Size and No Reflow in a Rat Myocardial Ischemia/Reperfusion Model
Authors: Wangde Dai, David A Brown, Robert A Kloner
Journal: Circulation (2022)

Background: We determined whether mitochondrial protective agents, elamipretide and SBT-255, could limit myocardial infarct (MI) size and the no reflow phenomenon in a standardized rat model. Methods and Results: Anesthetized rats were randomized into 3 groups (n = 15 in each group): (1) Saline control group; (2) Bolus dose of elamipretide (1 mg/kg body weight); (3) Bolus dose of SBT-255 (1 mg/kg body weight). The treatment was administered at 10 minutes after coronary artery occlusion. The coronary occlusion was maintained for 30 minutes followed by 3 hours of reperfusion. MI size (triphenyl tetrazolium chloride staining technique), expressed as a percentage of the ischemic risk zone (blue dye technique) was significantly lower in the SBT-255 treated group at 30.2 ± 5.0% versus 53.1 ± 4.0% in the saline group and 48.1 ± 5.1% in the elamipretide group (p=0.001). Area of no-reflow (thioflavin S technique) as a percentage of the risk zone was significantly smaller in the SBT-255 treated group (22.2 ± 5.4%) compared to the saline (38.0 ± 3.4%) and elamipretide groups (36.4 ± 5.0%; p=0.024). The Figure demonstrates the association between myocardial ischemic risk area and infarct size (panel A) as well as no-reflow size (panel B) among the 3 groups. The regression lines in both infarct size and no-reflow size shift downward in SBT-255 group compared to the saline and elamipretide group, indicating that, for the same size of risk area, the infarct size and no-reflow were smaller in the SBT-255 group than the other groups. Conclusions: SBT-255 treatment significantly reduced infarct size and no-reflow size compared to either saline or elamipretide treatment in an acute rat myocardial ischemia/reperfusion model.
Abstract 13171: Cardiac Rehabilitation and COVID-19: Nationwide Declines in Access and Participation Among Medicare Beneficiaries
Authors: Merilyn S Varghese, Alexis Beatty, Laurence S Sperling, Gregg C Fonarow, Steven J KETEYIAN, Kevin W McConeghy, Joanne Penko, Yang Song, Robert W Yeh, Jose F Figueroa, Wen-Chih Wu, Jiaman Xu, Dhruv S Kazi
Journal: Circulation (2022)

Introduction: The effect of the COVID-19 pandemic on availability of and participation in cardiac rehabilitation (CR) participation is unknown. Methods: We used Medicare Fee-for-Service claims, American Hospital Association surveys, and Rural Urban Commuting Area codes to evaluate CR center availability and CR participation (01/2019-12/21). Results: Medicare beneficiaries participated in a mean ± SD of 56,898 ± 2,046 CR sessions per month from 01/2019 - 02/2020. Immediately after the announcement of the public health emergency in 03/2020, CR sessions declined by 93% (to 3,989 sessions in 04/2020) (Figure). The monthly CR sessions recovered gradually through 12/21, but CR participation remained 17% lower than pre-pandemic levels (54,730 ± 2,340 sessions/month in Q1 2019 vs. 45,209 ± 326 sessions/month in Q4 2021, p&lt;0.01). Prior to the pandemic, Medicare beneficiaries received CR at 2,631 ± 8 CR centers. Only 688 centers were in operation in 04/2020 (a 74% decline from pre-pandemic levels), with slow and incomplete recovery in the following months. The number of CR centers in 12/2021 was 5% lower than pre-pandemic levels (2,620 ± 6 centers available in Q1 2019 vs. 2,485 ± 8 centers available in Q4 2021, p &lt;0.01). Ownership status (private/not for profit, private/for profit and public/municipal), teaching status affiliation (major, minor and none), and location (metro, micro and rural) were not associated with post-pandemic CR center availability. Conclusions: The COVID-19 pandemic has been associated with persistent declines in the availability of CR centers and participation in CR sessions among Medicare beneficiaries. Future studies should examine the impact of these closures on health outcomes and equity. Meeting the Million Hearts Initiative’s goal of equitably increasing CR participation will require scalable innovation in CR financing and delivery.
Abstract 13566: Predictors of Progressive QRS Duration in Left Bundle Branch Block
Authors: Nimai Patel, Christopher Grondin, J Matthew Nicklas, Tarek Makki, John M Nicklas
Journal: Circulation (2022)

Introduction: QRS duration in patients with left bundle branch block (LBBB) predicts adverse clinical outcomes and response to cardiac resynchronization therapy (CRT). Changes in LBBB QRS duration over time have not been reported. Hypothesis: QRS duration in patients with LBBB changes over time and may be predicted by patient demographics and comorbidities. Methods: We retrospectively identified 450 patients with LBBB on an index ECG (QRS ≥120 msec) recorded between 1992 and 2000 and examined any follow-up ECGs recorded after approximately 1, 2, 3, 5, and 10 years. Piecewise linear interpolations were performed, and separate generalized linear models (GLM) with Schwartz Bayesian Criterion effect selection were used to relate baseline clinical variables to changes in QRS duration at follow-up. Results: The cohort was 53.1% male, average age 66.7 yr, and mean index ECG QRS duration 144.7 msec. Although there was significant variability, the duration of the mean QRS increased as a tapering exponential function of time (p&lt;0.0001) with progressively less increase at later follow-up. Three additional variables strongly and independently predicted progressive lengthening of the QRS within the overall GLM: heart failure with reduced ejection fraction (HFrEF) (p&lt;0.0001), index ECG QRS duration (neg) (p&lt;0.0001), and male gender (p=0.0063). In a subgroup of patients with an index ECG QRS &lt;150 msec, these four GLM model variables also predicted the increase in QRS: time (p=0.0129), index QRS duration (p=0.0042), HFrEF (p=0.0001), and male gender (p=0.0084). (Equation, Figure below) ΔQRS(t;i) = 50.22 - 9.71*e -0.29*t - 0.344*QRS(0;i) + 7.62* 1 HFrEF (i) +5.12* 1 Male (i) Adjusted R 2 = 0.103 Conclusions: QRS duration progressively prolongs with time in patients with LBBB especially in patients with relatively narrow QRS and can be predicted by the presence of HFrEF and male gender. These predictors may be useful in better informing clinical prognosis and decisions regarding CRT.
Abstract 13282: Towards a Decision Support Tool for Opioid Administration and Sedation Management in the Pediatric Cardiac Intensive Care Unit
Authors: Sivaram Emani, Francesca Sperotto, Marlon Delgado, Lin Zhu, Mauricio Santillana Guzman, John Kheir
Journal: Circulation (2022)

Introduction: Opioids are commonly used to treat pain and agitation in the cardiac intensive care unit. However, responsiveness to opioids in pediatric patients is poorly understood, and few guidelines exist for personalized management of sedation. This leads to probable overprescription of opioids in the pediatric ICU, which can extend length of stay and have negative long-term health consequences. In this work, we build a decision support tool to predict a patient’s response to an opioid bolus measured by the state behavior scale (SBS), using available patient data at the time of administration. Methods: We built a dataset including all individual doses of morphine administered to patients admitted to the CICU between 2011-2020. Patients missing critical hemodynamic or SBS data were excluded from the analysis. The change in SBS score before and after morphine administration was converted to a binary outcome, where a decrease in SBS score was considered to be favorable (A). A LASSO regression model was trained to predict SBS response. The predictors utilized in the model included demographics, hemodynamic data, SBS score measurements before morphine, concomitant drug infusions/boluses and morphine response to prior doses. The model was trained on 80% of data and evaluated on 20%. Results: Of 197,242 intravenous boluses, 66,195 boluses administered to 6,021 patients (median age 7.2 mo) were included. The median change in SBS score was 0 (IQR -1 - 0) with 33% of administrations classified as favorable responses. The model coefficients are shown in (B). The model predicts 74% of unfavorable morphine responses with 95% confidence, AUC = 0.899 (C). Conclusions: Nearly three-quarters of ineffective responses to morphine can be predicted with 95% confidence using the prediction models developed. Such models could substantially reduce morphine over-administration for critically ill patients in the pediatric cardiac ICU.
Abstract 13138: Dissection of Cardiomyocyte versus Fibroblast Effects of Interleukin-11 in Heart Failure
Authors: Mark Sweeney, Katie O'Fee, Chelsie Villanueva-Hayes, Konstantinos Vanezis, Ekhlas Rahman, Anissa Widjaja, Derek Hausenloy, Paul J Barton, Stuart A Cook
Journal: Circulation (2022)

Introduction: Interleukin-11 (IL-11) is a cytokine produced in response to tissue damage and cellular stress and is secreted from and acts on both parenchymal and stromal cells across tissues. The relative contributions of IL-11 to cardiomyocyte dysfunction and fibroblast activation in heart failure pathologies are ill-defined. Hypothesis: IL-11 causes both cardiomyocyte dysfunction and fibroblast activation that leads to distinct pathologies common to heart failure syndromes. Methods: Cardiomyocytes were isolated from adult C57BL/6 mice and treated with recombinant mouse IL-11 (rmIL-11) or control for 2 hours. Cardiomyocytes were then incubated with a calcium indicator (Fluo-4AM) and stimulated at 1Hz to allow recordings of contractility and calcium transients. In vivo studies were performed using C57BL/6 mice which were injected with rmIL-11 2 hours prior to echocardiography under isoflurane anaesthesia. HFpEF was induced in C57BL/6 mice with diet containing 60% fat and drinking water containing the nitric oxide inhibitor L-NAME. IL-11 was conditionally overexpressed in cardiomyocytes of C57BL/6 mice using a Myh6 dependent cre-loxp system. Ventricular function was measured by echocardiography and molecular analysis was performed 6 weeks following induction of overexpression. Results: Acute treatment for 2 hours with rmIL-11 impaired contractility at both a cellular level in isolated cardiomyocytes and of the whole heart in vivo, as measured by echocardiography. The impairment in systolic function was associated with reduced calcium uptake in cardiomyocytes, an effect which was rapidly reversible. In a mouse model of HFpEF, IL-11 was elevated in the ventricle of treated mice as compared to controls with an associated increase in IL-11 dependent profibrotic gene expression. IL-11 expression in cardiomyocytes results in extensive fibrotic changes in the myocardium, notably peri-vascularly, and significantly reduces systolic function, as compared to control animals. Conclusions: IL-11 is increased in a mouse model of HFpEF, is negatively inotropic in vitro and in vivo and induces fibrosis when secreted from cardiomyocytes. Hence, IL-11 contributes to heart failure pathologies across cellular compartments in the failing heart.
Abstract 13253: Regionalizing Non-Pulmonary Vein Triggers for Atrial Fibrillation Using Timing and Activation Pattern of Intracardiac Electrograms From Two Linear Decapolar Catheters
Authors: Munveer Thind, Martin Arceluz, Irene Lucena Padros, Maciej Kubala, Bishnu P Dhakal, Weeranun D Bode, Maxime Cerantola, Maiwand Mirwais, Kelvin Bush, Gustavo Guandalini, Matthew C Hyman, David Lin, Rajat Deo, Saman Nazarian, Cory M Tschabrunn, Robert D Schaller, Andrew E Epstein, Gregory E Supple, David S Frankel, Pasquale Santangeli, David J Callans, Francis E Marchlinski
Journal: Circulation (2022)

Introduction Targeting non-pulmonary vein triggers (NPVTs) after pulmonary vein isolation (PVI) reduces atrial fibrillation (AF) recurrence. However, NPVTs are often single atrial ectopic beats with surface P wave obscured, making regionalization a challenge. We aimed to construct an algorithm to regionalize the site of origin of NPVTs using exclusively intracardiac electrograms from two standardly positioned linear decapolar catheters positioned 1) in the postero-lateral right atrium, along crista terminalis (CT) with distal bipole pair extending into SVC, and 2) in the coronary sinus (CS), with proximal bipole pair at CS ostium. Methods In 42 patients with AF, after PVI, we paced at 15 sites where NPVTs commonly arise (Figure 1). For each pacing site we analyzed activation sequence of the CS catheter electrogram (simultaneous/chevron/inverse chevron/distal-proximal/proximal-distal) and the timing (CSCT time) between the earliest electrograms from the two decapolar catheters. Negative CSCT time indicates CT catheter electrogram is earliest, positive indicates CS catheter electrogram is earliest (Figure 2, lower right). Results In this patient cohort (71% male, 57% persistent AF, 52% left atrial dilation), our algorithm was able to group the 15 pacing sites, into 7 clinically useful and distinct regions with high precision (positive predictive value range 81-99%, Figure 2). Conclusions An algorithm defined by the activation sequence and timing of electrograms from two linear multipolar catheters allows for accurate regionalization of NPVTs. This may be used to expedite identification of a region of interest to guide further focused detailed mapping of AF NPVTs.